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March 1, 2014Clinical Interventions in AgingOpen Access

Increasing complexity: which drug class to choose for treatment of hypertension in the elderly?

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Key result

Antihypertensive classes show equal cardiovascular efficacy in the elderly, shifting focus to cost and adherence.

Why the study?

What is the optimal drug class for the treatment of hypertension in the elderly?

Population

Elderly patients with hypertension

Design

Review

Authors

HSHendrik SchäferEKEdelgard KaiserULUlrich Lotze

Discussion

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Overview

May guide antihypertensive selection in elderly by cost and adherence; leaves open class superiority in dedicated RCTs.

Key Points

  • To review clinical trial evidence and guideline recommendations regarding optimal blood pressure targets and drug selection for elderly and very elderly patients with hypertension.
  • Reviewed clinical trial evidence up to 2013 alongside international guidelines including NICE 2011, JNC7/8, ESH/ESC 2013, CHEP 2013, and ASH/ISH.
  • Evaluated six primary drug classes: diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and direct renin inhibitors.
  • All major antihypertensive drug classes display equivalent overall efficacy in lowering blood pressure and reducing cardiovascular outcomes.
  • ACE inhibitor plus diuretic combinations are favored for systolic/diastolic hypertension, whereas calcium channel blockers plus diuretics are recommended for isolated systolic hypertension.
  • Collateral advantages dictate selection: ACE inhibitors and CCBs benefit patients with dementia, while CCBs and ARBs lower long-term costs through higher medication adherence.

Structured PICO

What is the optimal drug class for the treatment of hypertension in the elderly?

P
Population
Elderly patients with hypertension
I
Intervention
Antihypertensive drug classes (diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and direct renin inhibitors)
O
Outcome
Blood pressure reduction, cardiovascular outcomes, and collateral advantages

In elderly hypertensive patients, major antihypertensive drug classes are equally effective, suggesting that treatment selection should be individualized based on collateral advantages, cost, and avoidance of adverse effects.

Cite This Study

Schäfer et al. (2014) conducted a review in Hypertension. Antihypertensive drugs was evaluated. Current antihypertensive substance classes are equally effective for cardiovascular outcomes in the elderly, suggesting selection should be based on collateral advantages like cost and adherence.

synapsesocial.com/papers/6a0f387ea7a2fed64abdd472https://doi.org/10.2147/cia.s40154
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Antihypertensive Drugs in the Elderly—the Evidence of Benefit2001 · 3 citations
  2. 2Current challenges in antihypertensive treatment in the elderly2016 · 4 citations
  3. 3Hypertension in the Aging Patient Implications for the Selection of Drug Therapy1989 · 6 citations
  4. 4Practical recommendations for treatment of hypertension in older patients2010 · 20 citations
  5. 5Present and Prospective Clinical Therapeutic Options for the Elderly Patient with Hypertension2010